Category Archives: Women’s Health Medicine

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Are you Stressed? … or are you in Denial?

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Most people suffer from stress at some point in their lives. There is good stress and there is bad stress and how people cope with these stresses in different for each and every individual. It is all about how you cope with it. Showing signs of stress does not mean that you are a weak person, just human like everybody else.

But, the word stress is probably not used correctly at times. Many people are actually suffering anxiety, or running on adrenalin and then say they are stressed .The word stress is such a broad term. These days the word stress probably means either you have anxiety, or you are busy being busy.

What do we now define as stress?

Stress is the description used for strain, pressure or force on a system. That system may be you. Stress can be the result of trivial annoyances like driving in heavy traffic, or a life-altering major crisis such as the death of a loved one. Stress can also be someone being busy, or someone running on adrenalin too much. Like I said before, stress could also be someone who is suffering from anxiety and then terms it as stress.

Stress can be used both to refer to the event that is causing the disturbance or the effects of that event on your body. Usually when we say we are feeling stressed we are talking about the symptoms caused by our body’s stress response.

There are different forms of stress

There is no doubt that there are different forms of stress and probably the biggest issue for people these days is actually realising that their body is in distress. It is that constant low grade stress that affects so many people and causes so many issues in the body. That low grade stress is the one that eventually catches up with people and can sometimes have very detrimental effects.

Stress can be a cause of many health issues

The one thing we know for sure is that stress is a cause of a lot of our health issues, immune system issues, reproductive issues, gynaecological issues, mental health issues, respiratory and cardiovascular issues, sleep issues and so on.

Nobody is born stressed, or is predisposed to being stress. It is a learnt behaviour that can be unlearnt and that is why seeing someone to help with coping strategies around stress is so important. There are also supplements and medicines that can help to deal with stress more effectively too.

What are the Symptoms and effects of stress?

Some of the symptoms and health problems that can be caused or exacerbated by high levels of ongoing stress include:

  • migraine or tension-induced headaches;
  • insomnia, fitful sleeping or nightmares;
  • anxiety, anger or irritability;
  • low, irritable or unstable mood;
  • memory lapses;
  • shoulder, neck or back pain;
  • fatigue;
  • rapid heartbeat;
  • high blood pressure;
  • skin eruptions and worsening of conditions such as eczema;
  • heartburn, nausea (feeling sick), diarrhoea or constipation;
  • reduced libido;
  • shortness of breath;
  • problems with your immune system;
  • heart disease; and
  • chronic pain.

Like I mentioned before, stress can also affect the reproductive system, cardiovascular system, nervous system, immune system and so much more.

How stress affects your body

At the first sign of alarm, certain sensory nerves in your body are stimulated and hormones are released that automatically trigger physical reactions to stress. Your heart rate increases, blood is diverted to your muscles and brain, breathing rate increases, digestion slows down, saliva production stops (your mouth feels dry), perspiration increases and your pupils widen. You feel tense, you startle easily and your attention narrows to focus on possible threats.

This is the ‘fight or flight’ phenomenon, which makes your body tense, alert, and ready for action. After this reaction to a real or perceived threat, your body stays on alert until you feel the danger has passed. When the stressor is gone, the brain signals an ‘all clear’, and your body gradually returns to normal.

While some short-term stress is thought to be good for you, pushing you to make that extra effort in a sporting event or game, chronic or long-term stress can be harmful to your health. This kind of stress is when you feel under constant, intense pressure, or you just cannot see a way out of a terrible situation. The problem for some people is that they do not realise they are stressed, or they actually have anxiety, and their body is in the state of constant adrenal overload that eventually catches up with them and their whole body shuts down completely. We see this with adrenal fatigue and chronic fatigue

Dealing with stress

Dealing with stress effectively can be complicated, but usually involves:

  • general measures to improve your overall wellbeing; and
  • learning coping skills and setting healthy boundaries
  • specific steps to deal with stress and particular challenging situations.
  • learning what your triggers may be
  • learning ways to deal with stress and how to be more relaxed

It is about getting coping skills to deal with the body having to deal with stress, or at point of perceived crisis.

The word that we term “Stress” commonly results when you feel your resources — for example, time, money or skills — are insufficient to deal with your responsibilities. Take check of what is causing you stress and where you examine your demands and resources can be a useful first step in dealing with stress. There is where the practice of mindfulness is very useful and also talking to a counsellor/psychologist can help you identify triggers for stress and have coping skills to deal with stress.

Problem solving techniques and coping skills may help you with problems and issues creating stress. You may also need to work on limiting your obligations, or asking for extra resources to help you cope with stress better. You may need to accept that there are times in life where you simply can’t do everything that others in your life, or you yourself are expecting.

One way to help deal with stress is to maintain a healthier mind and body. Here are some of the things you can do to deal with stress better.

Ways to Deal With Stress Better
  • Regular exercise to help with stress and tension in the body. It also helps with moods.
  • Make sure you get at least 1-4 hours “You” time per week. Treat yourself to sufficient relaxation time so that you can switch off from you daily routine. This will help to give you a refreshed and energetic outlook on life. Learn yoga, meditation or other relaxation exercises such as mindfulness. There are some great mindfulness courses available now.
  • Make sure you get enough sleep. Melatonin is the hormone that helps you sleep and lack of sleep and stress depletes it. Lack of sleep also puts the body into distress.
  • Maintain a balanced diet. Without a balanced and health diet, your body will have inflammation and this will cause stress and disharmony in the body too.
  • Learn to accept what you cannot change but also learn to be more assertive, especially if you are one of those people who always say ‘yes’. Healthy boundaries are so important.  Assertiveness training, setting clear boundaries and learning to say no can be very helpful in avoiding overload.
  • Make sure you do something that you love at least 1-2 times per week. Spend time with people you enjoy seeing, listening to music, playing sport, reading a book, watching a funny movie, gardening etc.
  • Talk therapy and coping skills: Talk therapy with a trained professional that can help you deal with stress and help you with coping skills is very important.
  • Avoid the use of drugs or alcohol as a means of coping with stress.
  • Acupuncture and Chinese Medicine can help with stress and studies have shown that it is as effective as some medication and equal to talk therapy in its effect. ( http://doi.org/10.1371/journal.pumed.1001518)
  • There are natural medicines that may assist you deal with the effects of stress and please talk to a qualified healthcare professional how best these can help and what to use. Do not self prescribe ever.

How do I know if I need help?

Many people think that they can deal with stress on their own, but the truth is it is better to get a trained professional to help you deal with it properly. This way you commit to actively doing something too and you are also learning coping skills at the same time. You should consider seeking help if:

  • you constantly worry and have trouble concentrating;
  • you feel a lot of guilt;
  • your sleep, energy and motivation is poor;
  • you can’t be bothered doing things anymore;
  • you experience several of the physical symptoms associated with stress;
  • you recognise that you are turning to self-destructive behaviours for temporary relief;
  • everything and everybody around you is being affected by the way you feel; or
  • you feel as though there’s nowhere to turn.
  • Friends keep telling you that you look stressed, or look like you need to slow down

There are qualified professionals who can help you with dealing with stress. It is important that you do see the right person to help you and your individual situation. You can always speak to your doctor or healthcare practitioner and ask them for a referral to someone. There are also mindfulness courses and relaxation courses you can do also. Exercise it important and again, it is a good idea help from a professional to get started and keep going.

Please take the risk of burnout and running on Adrenalin tests below and see how you are fairing (see below)

Take care

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

Risk of Burnout Challenge
  1. Do you feel let down by other people around you?
  2. Are you too busy for close friends and family?
  3. Are you too busy to do even routine things like send out thank-you notes, return phone calls or mail birthday cards?
  1. Do you tire more easily than you used to?
  2. Are you working harder but accomplishing less?
  3. Are you increasingly cynical and disenchanted?
  4. Are you often invaded by a sadness that you can’t explain?
  5. Do you forget appointments, deadlines, possessions?
  6. Are you increasingly irritable? More short tempered?
  7. Does you body ache or are you having trouble shaking a cold?
  8. Are you finding it harder to be happy and joyful?
  9. Have you lost your sense of humour?
  10. Have you lost interest in sex or have a low libido?
  11. Are you less talkative than you used to be?
  12. Do you think of work all the time, even at rest?
  13. Do you find it hard to say ‘no’ to people or things that require your own personal time?
  14. Do you take time-out for others but do not take time-out for yourself?

Your score

To find your total , add up your “yes” answers.

(0 – 5) >> Cruising along nicely

(5 – 10) >>  Borderline burnout

(10 – 17) >> Burnout candidate

Running on Adrenalin Challenge

  1. I feel there isn’t enough time in the day to do all the things need to do.
  2. I speak more quickly than other people, even finishing their sentences for them.
  3. My relatives and friends say I eat too quickly.
  4. I would rather win than enjoy a game.
  5. I am very competitive at work, sports or games.
  6. I tend to be bossy and dominate others.
  7. I prefer to lead than follow.
  8. I feel pressed for time even when I’m not doing something important.
  9. I become more impatient when I have to wait for something or when I’m interrupted.
  10. I tend to make decisions quickly and compulsively.
  11. I take on more than I can accomplish.
  12. I become irritable and even angry, more than other people.
  13. I feel a strong compulsion to be doing something while at home or even on holidays.
  14. I fidget often and become restless, pacing, leg kicking, or fast gum chewing.
  15. I get a vague sense of depression whenever I stop an activity.
  16. I have forgotten how to, or don’t know, how to relax.

Score description

0 – This does not apply to me

1 – This statement applies to me less than once per month

2 – This statement applies to me on a regular basis

Total score

Out of a possible score of 32 you would have fallen into one of the 4 following categories…

(0 – 10) >> Relaxed

(10 – 15) >> Typical

(15 – 20) >> On the edge

(20 +) >> Adrenalin Junkie!

How to deal with endometriosis

How to cope with endometriosis and manage it moving forward

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Endometriosis can be a challenging condition to deal with, both physically and emotionally. But with proper interventions and proper management and treatments after diagnosis, you can be shown how to deal with the associated symptoms of endometriosis and improve your quality of life. Please have a read of some of the best ways to cope with endometriosis.

What is Endometriosis?

Endometriosis can be painful disorder that is characterized by tissue that behaves like the lining of the uterus but that grows outside the uterus. Endometriosis is really normal tissue growing in abnormal places. This tissue can be found in various places, such as the ovaries, fallopian tubes, and pelvic lining, and even in or around the bladder and bowel.

Endometriosis affects around 1 in 10 women and girls and those are only the ones diagnosed. This mean these figures are grossly under-diagnosed and downplayed with many women not being diagnosed properly and those that do not even know they have the disease. Endometriosis can cause symptoms during the reproductive years, between the ages of 12 and 60, but it can show up in young girls under 10 years old too.  Many people with the condition remain undiagnosed and many more and missed and dismissed with many taking up to ten years or more to be diagnosed.

What are the symptoms of Endometriosis?

The main symptom of the condition is usually pelvic pain typically associated with the menstrual period. While women can experience some discomfort during their menstrual period, some of those with endometriosis describe pain that is worse than usual. For some it is actually unbearable.

There are also other symptoms such as painful periods, pelvic pain, ovulation pain, pain with sex, chronic fatigue, irritable bowel like symptoms, bladder issues and pain and bleeding on bowel movement. This is why all women need to know that period pain is not normal, because many times, period pain can actually be a sign that a woman has an underlining gynaecological conditions such as endometriosis.

We also need for everyone to know that endometriosis is not just about period pain. There are many other symptoms women face when dealing with endometriosis.

There is no cure, but there ways to manage Endometriosis

There is no cure for endometriosis (not yet anyway), but there are treatment options and lifestyle changes that can ease your symptoms so that the condition does not interfere with your day-to-day life.

The main thing with endometriosis is to manage the disease and try and create a quality of life moving forward. While there is no cure for endometriosis, it is possible for women to become asymptomatic (meaning having no symptoms) and this requires the right treatments and management of the disease and to see the right people from the beginning.

Again, it all gets back to who you are seeing and their experience with knowing about endometriosis. This is one the biggest issues women face when trying to get treatment. Many just do not know much about the disease at all and why women are left to deal with the horrible symptoms. But with the right treatment and management, women can have a better life and be able to cope with this horrible disease.

Before we look at proper management for women with endometriosis, it is important that all understand the facts because there is so much misinformation out there and this is part of the bigger issue for women with this disease.

Surgical intervention and medications alone are not enough

While surgical interventions are hormones/medications are needed for women with endometriosis, alone, or in combination are not enough. We know that despite the best surgical and medical intervention that women are still in pain and still having the associated symptoms of endometriosis. This is why women do need a multimodality/team approach, and a combination of different modalities to effectively manage endometriosis.

The problem for many is that once they have the surgery, they believe their endometriosis is gone, or that they don’t have to do anything else. This is where many go wrong and why they end up having to have multiples surgeries. Women need proper ongoing management after surgery, which includes medications, hormones, other therapies, counselling, physiotherapy, mindfulness, exercise, diet and lifestyle interventions and so much more. Without this, endometriosis cannot be effectively managed.

The Facts About Endometriosis

  1. Period Pain IS NOT Normal
  2. A significant portion of women with Endometriosis are asymptomatic
  3. Symptoms DO NOT correlate to the extent of the disease
  4. The only way to diagnose Endometriosis definitely is via surgical intervention
  5. There is NO cure for Endometriosis
  6. Having a baby will not cure endometriosis
  7. Endometriosis does not always cause infertility
  8. Endometriosis is Estrogen Driven and is not caused by Estrogen dominance
  9. The Pill, or Contraceptives DO NOT fix endometriosis
  10. You can have Endometriosis at a Young, or Older Age
  11. Hysterectomy does not cure endometriosis
  12. Endometriosis requires a multi-modality approach to be managed properly. You need a team for proper management
  13. Endometriosis IS NOT an autoimmune disease
  14. There Are Hereditary and Genetic links
  15. Endometriosis can cause many other issues in the body
  16. The first line approach for hormone therapy should be the use of progesterone only options
  17. Endometriosis needs to be excised (cut out) by an advanced laparoscopic surgeon, who has had extra years of specialised surgical training, and who specialised in the excision of the disease and specialised in the disease itself. Surgery should be performed by anyone other than an advanced laparoscopic surgeon and not by just a regular gynaecologist
  18. Not all women with endometriosis have suffered sexual abuse
What Women Can Do To Help Manage Endometriosis

1.Seeing the Right Specialist & Surgeon

First and foremost make sure you have seen someone who specialises in endometriosis and the management and treatments moving forward. You also need to make sure that your first surgery is your best surgery and that you have seen an advanced laparoscopic surgeon to ensure you have had the proper surgical intervention. This is many women’s biggest issue as they have not seen the proper surgeon initially and they aren’t seeing someone who specialises in the management of the disease moving forward.

2.Watch your diet

Eating the right foods may provide some protection from the symptoms of endometriosis. The role of diet in endometriosis has been investigated in recent years due to the influence of diet on some of the processes linked to the disease, such as inflammation, prostaglandin metabolism, and estrogen activity. Many of the so called endometriosis diets out there are now outdated and have outdated nutritional and dietary advice that don’t really help much at all. Women need to adopt an anti-inflammatory diet (grain free, non-refined food ) to help with settling any inflammation in the body and also helping the immune system. This also needs to include prebiotic and probiotic bacteria to help with digestive function, immunity and gut health.

Certain environmental estrogens such as preservatives, plastics, pesticides and insecticides that can be ingested through certain nutrients have been suggested as risk factors for exacerbating endometriosis too.

Excess body fat, now known as obestrogens (because it is estrogenic) needs to be controlled and managed through diet and exercise too. We know that estrogen drive endometriosis and that any estrogens (dietary, body fats, environmental etc) needs to be regulated and controlled.

3.Boost intake of omega-3 fatty acids

Researchers have also found that the type of fat included in your diet makes a difference in your risk of endometriosis. Studies have shown that people whose diets were heavily laden with trans fats increased their risk of the expression of endometriosis by 48 % when compared with individuals who ate the least of these. By comparison, women whose diets were rich in omega-3 oils lowered their risk of endometriosis by 22 % compared with those who consumed the least amount.

Eating foods high in omega-3 fatty acids, such as salmon, flaxseeds, almonds, and walnuts, may be helpful for endometriosis. Women should also be supplementing with Omega 3 oils too. Just remember, it is all about reducing inflammation.

4.Exercise

Often, people who experience pain fear exercising, in case it causes more problems for them. But over time, regular physical activity may decrease the pain and discomfort that you feel. High-intensity exercise and resistance training can help to reduce the symptoms of endometriosis.

Exercise may help those with endometriosis in many ways, including:

  • encouraging the circulation of blood to your organs
  • maintaining nutrients and oxygen flow to all your body systems
  • decreasing estrogen production
  • reducing stress
  • releasing endorphins in the brain, which are pain-relieving, “feel good” chemicals

Women who regularly exercise may be likely to have the symptoms associated with endometriosis. Research has shown that those who engage in frequent high-intensity physical activity have fewer symptoms of  endometriosis than women who do not participate in regular exercise. High-intensity physical activity, such as running, swimming, weight training etc, may be beneficial for reducing your symptoms.

Low-intensity exercise, including Yoga and Pilates may provide some relief in endometriosis, too. Yoga and Pilates can stretch and strengthen your muscles, help with core strength, help with circulation, which all may be beneficial for pelvic pain management and stress reduction.

5.Managing Stress Levels

Stress is a big factor in any disease and can make any disease worse. Not only can stress be exacerbated by endometriosis, but so can endometriosis symptoms be exacerbated by stress, in a never-ending cycle. Endometriosis could contribute to making your stress levels worse, due to the impact that the associated symptoms have on all aspects of your life, including family and personal relationships and work.

Stress management, Counselling, Mindfulness and Relaxation techniques can help to reduce stress that exacerbates endometriosis-related symptoms and pain.

Women with endometriosis need to manage stress by using mindfulness and relaxation techniques. These can help you to increase your awareness of your body, refocus on something calming, and reduce the activity of stress hormones and inflammation in the body. It is all about learning coping mechanisms and what works best for you, not what works best for others.

6.Try complementary medicine and therapies

Many women with Endometriosis find symptom relief from using a range of different complementary and alternative medicines. The Royal College of Obstetricians and Gynaecologists also recommends that women try natural medicines to help with the management of endometriosis and the associated symptoms. There is now some good research to support many natural medicines treatments such as acupuncture, Chinese herbal medicine, vitamins, omega 3 oils, probiotics, chiropractic/osteopathy, yoga, pilates and more, alongside medical interventions.

Acupuncture and Chinese medicines has some good research around period pain and pelvic pain and may be beneficial to those suffering this disease and its associated symptoms, alongside medical interventions.

Certain strains of prebiotics and probiotics have also been shown to help with the immune system, microbiome, bowel, and digestive associated symptoms of endometriosis. Probiotics have also been shown to not only help with digestive and immune function, but also with the psychological function as well. It does need to be specific strains of probiotics though.

Just like with medical treatments, when it comes to complementary medicines, it is important to find someone who is a qualified practitioner and who specialises in endometriosis. Just like in the medical model, this can also be hard to find.

7.Medications

Your endometriosis specialist can provide you with a list of treatment options for endometriosis and outline the risks and benefits of each. They will take into account your age, your symptoms, whether you want to become pregnant, and any treatments that you have had previously. It is important to manage pain and inflammation so that you can have a life and to be able to function daily.

You may need to use different forms of pain medications on script, as well as those that can be purchased over the counter. Please ensure you speak to your healthcare provider about setting up a pain management plan when using medications

You will also need to look at hormone therapy to help slow down the growth and expression of the disease and microscopic implants and also help with the associated symptoms of the disease. Hormones will usually be in the form of progesterone only medications and gonadotropin-releasing hormone antagonists and agonists. You may be prescribed other hormones depending on your individual case and symptoms.

Although all of these hormone therapies are effective at treating endometriosis, but,  they all have different side effects. You need to talk to your doctor and pharmacists about the side effects and risk factors of any medications and hormones that you are taking.

In Summary

It is important to know that women with endometriosis will need a multi-modality, or team approach to deal with this disease. The team you need and modalities that you will need will be dependent on your individual symptoms.

Try and find healthcare professionals that can offer you a multi-modality approach for ongoing care and support and who also have a team of other people who are experts in the disease too. Again, the approach that you and your healthcare profession choose to take will vary depending on your signs and symptoms, and whether or not you would like to become pregnant in the future.

Before starting any treatment, it is important to know all of your options and the potential outcomes of all of them and to know that the people that you are seeing are and expert in endometriosis and know how to manage the disease properly. That can often be the hardest thing to find and why you need to do your homework and see people who are experts in this area of medicine.

Regards

Andrew Orr

-No Stone Left Unturned

-Period Pain IS NOT Normal

-The Endometriosis Experts

Incontinence and bladder issues

Incontinence, Bladder issues and Weak Pelvic Floor

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Incontinence is often an embarrassing condition that will have more than a third of people suffering in silence because they are too embarrassed to seek treatment. Both men and women can suffer incontinence.

Although patients don’t die of incontinence, they often can’t live a fully productive life, they may have to curtail their workload or change jobs. Many factory workers and school teachers are only allowed set times for toilet breaks, so patient with urge incontinence may have to change jobs.

Patients who work in the military or the police force may have to resort to desk jobs. Too many women with incontinence stop having sexual intercourse, either because they are afraid they will leak during sex, or else they actually do leak, either at penetration, or at time of orgasm, which can be very disastrous. While men can also suffer incontinence, I am mainly going to focus on the causes of incontinence in women for this post.

Many people do not seek treatment

Many people don’t seek treatment because they also believe that surgery is their only option. Nothing could be further from the truth and surgery should only be used as a last resort once conservative methods have been used and aren’t working.

Even then, the surgical approaches used today are less invasive, are very effective and the recovery is very quick. It is not like it was 10-20 years ago. Keyhole surgery has really made major changes in this area and new surgical techniques are so highly effective.

I know people want to avoid any surgery, but sometimes it is needed and these days the recovery rates are so quick. A few days out of your life for recovery, can actually change your whole life. I just do not understand why anyone would put up with a life with incontinence, prolapse, or weak pelvic floor, when these issues are so easily fixed these days. I know many patients are so amazed at how easily their incontinence issues was fixed and how amazing they feel in getting their life back again. No more leakage when they laugh, cough, or exercise.

Incontinence does not have to be a normal part of life

Some people never seek treatment believing that incontinence is just a normal part of life. Again, this is not true and all and I encourage anyone with incontinence to talk to Urodynamic/Pelvic floor specialist, so they can help treat you and can also refer you to the right people for treatment and management if needed.

I know the pelvic floor/urodynamic surgeon I work closely with is amazing and what he can do for women and these issues is amazing too. Then I just help with the management on a more multimodality approach, moving forward.

Surgery may be necessary, but not always

Like I said before, surgery isn’t always needed. Many times conservative measures such as pelvic floor exercises, core strengthening, bladder toning, topical estrogen therapy, internal TENS (electrostimulation) and pulse magnetic therapy can all product fantastic long term treatment to this often debilitating condition, without the need for surgery.

There are also some special rings and other devices that can be used to prevent leakage and support prolapsed bladder and also vaginal prolapse causing incontinence. Men with incontinence also have options at hand and these can also be explored well before surgery is needed.

What people need to be aware of too, is that if you have been doing all the conservative treatments, and they aren’t helping, then it is time to get some surgical intervention. I think people think that pelvic floor exercises with fix all bladder and pelvic floor issues, and this doesn’t work, then there is nothing that can be done to help them. I need for all women (and men) to know that there is always help for bladder and pelvic floor issues and you just need to see a specialist, not just your GP.

Natural Medicines

On a natural medicine level, acupuncture and chinese herbal medicines may assist in the treatment and management of pain, alongside medical treatments and interventions.

Yoga and Pilates may also help toning of the pelvic floor and help managing incontinence, pelvic floor and post-surgical management of prolapse too.

How incontinence and other bladder issues is defined

Incontinence and bladder issues are defined as needing to pass urine more than 8 times per day, leakage of urine through cough, sneeze, urge, or without cause. It is important to seek help if you notice damp underwear, need to use pads because of leakage or are constantly running to the loo to pass urine.

The different types of incontinence

There are many different types of incontinence with the main ones defined as stress incontinence, urge incontinence and voiding dysfunction/incomplete emptying.

There is also mixed incontinence (mix of the 3 main ones) and also a term called overactive bladder syndrome which can be a mixture of all forms of incontinence. There are also inflammatory bladder conditions that cause incontinence such as bacterial cystitis and interstitial cystitis.

Physical issues such as previous surgery, childbirth and prolapse can also cause incontinence too.

The first task for the clinician is to find out how severe the incontinence is, based on the frequency of leakage, whether the woman finds it necessary to use incontinence pads, and if so how many pads. Some patients may prefer to change their underwear more frequently, while others may tuck tissue paper inside their underwear, and just throw away the tissues whenever they are damp.

The classic feature of stress incontinence is that the patient leaks with coughing, sneezing, laughing, running, playing sport or lifting heavy objects

The classic feature of urge incontinence is that the patient rushes to the toilet with an urgent desire to pass urine, but as she gets to the loo and is taking down her trousers, the urine comes away from her- sometimes before she has even sat down. Unfortunately these patients cannot predict when these bladder spasms will come upon them, and therefore can’t really tell when they are likely to leak.

Nocturia is defined as being woken up by your bladder needing to go to the toilet- as opposed to being woken up by a crying baby, a snoring husband, or menopausal night sweats. However nocturia is age dependent. Nocturia is defined as waking 1 or more times per night if under 60 years of age

Typically a patient with Voiding dysfunction/ Emptying difficulty has to strain to commence voiding (called “hesitancy”). They may also have observed that when they compares themselves to other women urinating in the toilets at the movies or in airports, her stream seems poorer than others with the urine dribbling out more slowly. These women will often also describe the sensation of incomplete emptying and may need to go back to the toilet within a relatively short time to re-void. Sometimes these women will leak as they get off the toilet, which is how the realise that they are not empty. This is called post-micturition dribble incontinence.

Incontinence in males

In males these symptoms most commonly occur when the prostate gland is enlarged- causing a relative urethral obstruction and making it more difficult for the urine to get out. These men have chronic high residual urine, so they end up going to the toilet very frequently in a vain attempt to empty out. They often dribble urine onto their clothes. When such men have prostatic surgery they usually find that their urine flow rate returns to normal and they usually stop dribbling.

Inflammation in the bladder leading to pain

We will also need to explore how inflammation of the urinary bladder leads to suprapubic pain, and consider the two main causes of this, Bacterial Cystitis and Interstitial Cystitis .It often feels difficult to treat incontinence in the presence of bacterial cystitis, because such patients are overwhelmed by frequency and urgency of micturition and they may experience disabling suprapubic pain. It is fixable with the right treatment though. It all gets back to who is managing you.

On the other hand, a separate cause of Urinary Pain, called Interstitial Cystitis, does not usually cause much incontinence at all- it just causes suprapubic (bladder) pain with severe frequency and urgency of micturition. You can read my post about Interstitial Cystitis

The overactive bladder (OAB) is a clinical syndrome, not a urodynamic diagnosis. It comprises frequency, urgency, and nocturia, with or without urge incontinence.

Gynaecological conditions such as Endometriosis and Adenomyosis etc can also cause issues with bladder and pelvic floor.

Please read my post on Atrophic vaginitis as this is also another cause of weakness in the pelvic floor and bladder and could be a cause of incontinence.

Solutions for incontinence, bladder issues, & pelvic floor issues

No matter what sort of incontinence you have, there is always an answer and a solution to your problem. Not all solutions are surgical either. More often than not some conservative treatments, some exercises and some complementary therapies is all that is needed.

Sometimes all some women need is some treatments with estrogen creams to help with tone in the vagina, bladder and pelvic floor

Surgery and now bionic devices are always an option for those whom have tried conservative options and aren’t getting the desired results. Surgery is often used because of quality of life issues. Again surgery these days is so effective and less invasive and the recovery is so much quicker due to keyhole surgery and new surgical interventions.

See a Urodynamic Specialist

If you are experiencing incontinence or bladder issues, please talk to your healthcare practitioner and please book in to see a good pelvic floor/urodynamic specialist, This way  you can be evaluated properly and see what is going on and implement the right treatment strategies to get your quality of life back again.

Many times there may be an easy non-invasive treatment for your particular issues. Even when surgical intervention is needed, these days even this is less invasive than it used to be and the recovery and results are very quick.

Please read my post of Atrophic Vaginitis as well as this all ties into this area too, especially for those women in the menopause and post menopausal time of their life.

Regards

Andrew Orr

-No Stone Left Unturned

– Women’s & Men’s Health Advocate

-The Women’s Health Experts

The world needs to know that period pain is not normal

Period Pain “Is Not” Normal and Doctors in Australia and The Rest of The World Need to Start Listening

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Millions of women around the world are told that period pain is normal and then go on to endure years of suffering and even infertility because it. Some women have endured so much pain and been “missed” and “dismissed” by so many healthcare professionals so many times that they have taken their own life because of it. It just should not happen and it needs to stop.

One of the major causes of period pain is Endometriosis, or its sister disease Adenomyosis. This crippling disease can cause period pain, pelvic pain, joint pain, pain with bowel movement, irritable bowel syndrome, pain with ovulation, swollen painful belly (known as endo belly), chronic fatigue, anaemia, heavy painful menstrual flow and can lead to infertility. Some women will quite literally not even be able to work due to debilitating symptoms of this disease.

It is estimated to affect 176 million worldwide and affect one in ten women, but that is only the ones diagnosed, so those figures are grossly understated. The facts around the disease are also grossly understated and poorly understood by many and why so many women are “missed” and “dismissed” by all the so called healthcare professionals they have seen.

The other issue for a significant portion of women with the disease, is that they are asymptomatic (meaning no symptoms) and do not even know that have it. Many of them may never be diagnosed unless they are having problems falling pregnant, and even then many of them are not investigated properly to see if endometriosis is the cause of their long-term struggle to have a baby. It really is disgusting on so many levels. There is no other way to put it.

Of those one in ten women actually diagnosed many of them have taken up to ten years, or more, to be diagnosed and have their disease “missed” and been “dismissed” by multiple healthcare professional during their debilitating journey to find an answer for their sufferings. It is a nightmare of epic proportion for women world wide and the nightmare needs to end and healthcare professionals and everyone else needs to become educated and start listening to women and getting the message out there that “Period Pain IS NOT normal”.

So many women worldwide are suffering from period pain, pelvic pain, pain during sex, or infertility and endometriosis is the first thing that needs to be ruled out.

Young women in particular have trouble convincing people they are having more than just bad period pain. So many young women (and older ones) are told just to “Suck it Up”, or “Deal with it”. Many mothers will even tell their daughters “This is just normal”, or “This is just what happens”, or “I have to put up with this, so you need to as well”, when in fact nothing could be further from the truth. Teenagers are not too young to have the disease and have it diagnosed and investigated either.

Early intervention, diagnosis and management is crucial when it comes to endometriosis. The longer the disease is left, the harder it is to treat and manage, and left untreated can cause a woman years of debilitation and misery in every aspect of her life, years of surgery, years of pain killers and opiates, even after the best medical treatment.

Healthcare providers and women around the world need to know that the longer it takes to diagnose, the longer the disease is there and the more damage it can do inside the body. Some women will have their lives crippled by not having early intervention. Some women have got to the point that they can no longer put up with the disease and being dismissed and have either attempted taking their own life, or have succeeded in doing so. It is just so wrong that women get to this point.

The other issue that women face, once they are diagnosed, is that many of them end up seeing the wrong specialist to do their surgery. While most gynaecologists can do investigative surgery, many of them are ill-equipped to surgically remove the disease and actually do not specialise in the disease, or the excision of the disease properly. Many women are under managed surgically, which then leads to further complications and the need for multiple surgeries later on.

So many women have not seen the right specialist, who has not investigated and managed the disease properly and then left women to deal with the consequences of this inadequacy in their scope of practice.

Women and healthcare providers need to be educated that women who potentially have endometriosis, or have a high likelihood of the disease, need to see an Advanced Trained Laparoscopic Surgeon, who has had extra specialised training in the excision of the disease and who has had extra specialised training in the management and treatment of the disease as well.

Just because someone is a gynaecologist, or specialist, does not mean they are a specialist in the disease. This is also a huge misunderstanding when women require diagnosis and management of the disease and why so many are still left with crippling pain and symptoms, even after medical intervention. Quite simply, they have just seen the wrong person for the job and this also needs to be addressed in education and training around this disease.

The National Institute for Health and Care Excellence (NICE) in England has released the first ever guidance on managing this horrible disease that affects millions of women worldwide. They are hoping it will not only help GP’s and healthcare providers in the UK, but also GP’s and healthcare providers here and around the rest of the world too.

NICE is calling for GP’s in Australia and the rest of the world to stop overlooking symptoms of this disease, such as bad period pain, so that women are not “missed” and “dismissed” for up to a decade or more. NICE are asking for endometriosis to be taken more seriously than it presently is and while that is starting happen here in Australia and the rest of the world, the changes have still been too slow. It really is just not good enough given that so many women are suffering from this debilitating disease worldwide. The Australian government is listening, and much has been achieved, but the action plan has been slow to implement and there needs to be more done. Other countries need to follow suit too.

One of my motto’s is that “Period Pain IS NOT Normal” and I will continue to say this forever and a day and it is great to see national health care bodies like NICE actually backing that up and trying to get healthcare providers to do the same. While others are slow on the uptake, I will never stop in my quest to get women the help they need for this disease and will do my best to stop women being “missed” and “dismissed” and get them the help, care and attention they need and hopefully be a part of one day bringing an end to this debilitating disease.

Let’s hope governments and all healthcare providers finally start listening to the facts about endometriosis too. Let’s end the silence and get this information out there to everyone.

If you do want to find out more about the facts about period pain and this disease, you can visit my webpage, or you can also visit Endometriosis Australia at www.endometriosisaustralia.org.

I have a special interest in the treatment and management of this disease and spend countless hours researching and presenting education to both practitioners and public alike. I also see the consequences of this disease in my practice daily and have been assisting women with endometriosis for many years. I want every woman on the planet to know that Period IS NOT Normal and that there is help out there too.

Take care

Regards

Andrew Orr

-“No Stone Left Unturned”

-“Period Pain IS NOT Normal”

-The Endometriosis Experts

Lichen Sclerosus

What Is Lichen Sclerosis?

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Lichen sclerosis is a long-term problem of the skin. It mostly affects the genital and anal areas. Sometimes, lichen sclerosis appears on the upper body, breasts, and upper arms.

For this article I am just going to talk about Lichen Sclerosis of the genital region (Vulva) and more around how this affects women and how it can be treated and managed.

Lichen sclerosis can cause itching, pain and scarring of the affected areas, but there are treatments available that can relieve symptoms and prevent and treat scarring.

Much of the information out there is also outdated and it all seems to be doom and gloom, so I wanted to do a post and put some positive options up for sufferers. With the right treatment and management, women with Lichen Sclerosis can get their lives back.

Who Does Lichen Sclerosis Affect?

Nobody knows exactly how many women are affected, but it is thought that as high as 1 in 30 women could suffer from Lichen Sclerosis. While anyone can get lichen sclerosis at any age, women after the menopause have the highest risk. In fact, it is about 10 times more common in women than in men. It is possible, but rare, for children to be affected.

What Are the Symptoms?

Early in the disease, small white spots appear on the skin. The spots are usually shiny and smooth. Later, the spots grow into bigger patches. The skin on the patches becomes thin and crinkled. The skin may also be inflamed and red or ulcerated from scratching.

Skin affected by lichen sclerosis can tear easily, and there may be tiny fissures (cracks in the skin). When severe, there may be bleeding and blistering.Sometimes, the skin becomes scarred. If the disease is a mild case, there may be no symptoms. 
Other symptoms are:

  • Itching (very common)
  • Discomfort or pain
  • Bleeding

Many women with lichen sclerosis are often misdiagnosed as having thrush because it too can also causes itchiness around the vulva.

Many women I see also have vaginal atrophy, which can be missed due to the focus on the lichen sclerosis. Women who have  vaginal atrophy can also have pain with intercourse, and atrophic vaginitis can also exacerbate the symptoms of lichen sclerosis. It can be a vicious cycle if it isn’t properly diagnosed.

Some women may have lichen sclerosis, atrophic vaginitis and thrush combined and this is why differential diagnosis is so important and women need to see someone who knows about how to diagnose these issues correctly.

Women need to see someone who specialises in this area and treats these conditions often. With correct treatment and management, women can live very normal lives.

Genital lichen sclerosis

Lichen sclerosis that affects the vulva usually feels intensely itchy. There may also be pain, stinging, burning or discomfort, especially during sex or when urinating.

Lichen sclerosis is a chronic, or ongoing, condition, and over time it can lead to scarring. If this affects the vulva, it may narrow the entrance to the vagina, interfering with sexual intercourse.

Women with severe lichen sclerosis in the genitals may not be able to have sex. The disease can cause scars that narrow the vagina. Also, sex can hurt and cause the patches to bleed.

However, treatment with creams or ointments can help. Women with severe scarring in the vagina may need surgery, but only after lichen sclerosis is controlled with medication. When the skin around the anus is affected, pain when emptying the bowels can lead to constipation.

Four out of 100 women will go onto develop cancer of the vulva and this is why early intervention and management is so important.

What Causes Lichen Sclerosis?

Doctors don’t know the exact cause of lichen sclerosis. Some doctors think a too active immune system and hormone problems may play a role. In women, lichen sclerosis also seems to be associated with autoimmune diseases (conditions where the immune system attacks the body), such as lupus , alopecia and thyroid disease.

It is also thought that people inherit the likelihood of getting the disease.

There may also be a hormonal involvement as It is also more common after menopause, when there is less oestrogen in the body. This is why careful differential diagnosis is so important, so that other conditions are not overlooked as well. This is something that I see happen to women often.

Lichen sclerosis is more likely to appear on skin that has been damaged or scarred from some other previous injury. Importantly, lichen sclerosis is not infectious and your partner cannot catch it during sex.

How Is It Diagnosed?

Lichen sclerosis can often be diagnosed from the appearance of the affected skin. It is important that your GP refer you to a pelvic floor/urodynamic specialist, or women’s health specialist that specialises in conditions affecting the female reproductive organs. Sometimes a referral to a dermatologist may also be needed also.

Besides visual diagnosis, a biopsy may be recommended to confirm the diagnosis. This involves taking a small sample of affected tissue for a pathologist to examine under a microscope. This allows specialists to make sure that it is not a different disease.

Treatment of lichen sclerosis

Treatment of lichen sclerosis is aimed at:

  • Relieving symptoms of itch and discomfort;
  • Healing the lesions (returning the affected skin to its normal colour and texture);
  • Preventing the development of scar tissue; and
  • Treating any scar tissue that has developed.

Medical Treatments for Lichen Sclerosis

Lichen sclerosis is usually treated by applying a strong steriod cream, or ointment to the affected area. This is usually applied daily for several weeks, or months, and then less frequently (once or twice per week) long-term to prevent a recurrence.

Corticosteroid ointment or cream should be applied only to the white patches and gently rubbed in. Try to avoid applying steroid to the normal surrounding skin to help prevent side effects.

Symptoms such as itch may improve within a couple of days of starting corticosteroid treatment. Healing of lesions generally takes longer.

Women with Lichen Sclerosis will need regular follow up consultations and management with their specialist while using these creams and ointments for a long time because they can cause the following

  • Thinning and redness of the skin
  • Stretch marks where the cream is applied
  • Genital yeast infections.

Sometimes, women just do not get better using this medication and there could be other things that could be stopping symptoms from clearing up. This could be from the following:

  • Low estrogen levels
  • Infection
  • Allergy to the medication.

Other treatments

If topical steroid treatment is not effective, your specialist may recommend other medications and treatments that target the immune system and help control inflammation.

  • Sometimes other medications such as Retinoids, or vitamin A-like drugs are used and your specialist may also recommend laser treatment.
  • If scarring has occurred, this does not usually improve with steroid treatment. Scarring in females that is affecting sexual intercourse or urination may be helped by surgery
  • There are also some new medical treatments that are presently being researched and providing some amazing results options and I will discuss at a later date. They are actually natural medicines that are being used as a medical treatments. All I can say is that I have seen the results of this new treatment option and I think it is going to help many people. At present on of my colleagues  is using this treatment to help women as part of a research project. I will update people when I am allowed to say more about this new treatment.

Natural Medicine Treatments

There are natural medicine treatments that may assist in the management of Lichen Sclerosis, alongside medical interventions.

Self-care measures for genital lichen sclerosis

The following self-care measures may help in the treatment of lichen sclerosis that affects the genital area.

  • Gently wash the area daily with warm water and pH neutral soap cleanser.
  • Try not to rub or scratch the area. This can sometimes be really hard when it is itchy and inflamed
  • Avoid tight clothing and any activities that may aggravate itching and discomfort, such as bike riding.
  • Your specialist may recommend you apply cream to gently moisturise and protect the area.
  • Women should use a mirror to become familiar with the location and appearance of their genital lesions, and to apply cream or ointment to the affected area of the vulva.

Complications and follow-up

If you have been diagnosed with lichen sclerosis then it is advisable to have regular follow-up appointments with your specialist every 6 to 12 months.

In addition, genital lichen sclerosis is associated with a small, but important, increase in the risk of cancer developing at the affected site. As mentioned before 4 out of 100 will go on to develop cancer of the vulva.

This is why frequent check-ups are important to detect any cancers early on, when they can be more easily treated. This is why I always say that early intervention and proper treatment and management of any disease and the same goes for lichen sclerosis.

I have helped and assisted many women with Lichen Sclerosis in my years in practice and I do find that a multimodality approach is the best way to assist and manage this disease effectively.

Sometimes you need to have a team to help treat this, just like many other diseases women endure.So many women are are at their wits end with this disease and all sorts of treatments that have not worked. The problem is that they have just seen the wrong people and haven’t been properly looked after.

Women with Lichen sclerosis can be helped if they see the right people and get the right help and proper clinical health care and management. You just need to find the right people who know about this disease and how to treat it properly.

I can say this, if this disease is treated and manage properly, it can give women their quality of life back. Instead of all the doom and gloom and negatives things, let’s get some positivity back and give women with this disease some hope. There always hope and you just need to know where to find it.

Take care

Regards

Andrew Orr

Women’s & Men’s Health Advocate

-“No Stone Left Unturned”

-The Women’s Health Experts

 

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Women with PCOS Have Four Times Higher Risk of Developing Type 2 Diabetes

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One of the hardest things I find that is hard to get through to women with PCOS, is their risk factors for type 2 diabetes, gestational diabetes and their increased risk of cardiovascular disease. They just aren’t being educated about it either.

It has long been known that the major driving factor behind PCOS is insulin resistance and this also increases the risk factor of developing diabetes for those with this endocrine/reproductive disorder.

Polycystic ovary syndrome is an endocrine/reproductive disorder that affects millions of women of reproductive age worldwide, and a new study has shown that it also put these women at a significant risk of developing type 2 diabetes.

PCOS is also the leading cause of female infertility and many women with this condition are often misdiagnosed, or do not know that they have it. PCOS is also a risk factor for miscarriage too. Please see my other posts about signs and symptoms of PCOS.  (Click Here)

All women with PCOS will have insulin resistance, either hereditary insulin resistance, or purely caused by diet and lifestyle choices. Insulin resistance is a condition wherein the muscles, fat, and liver do not respond properly to the hormone, so the body keeps producing more of it.

Excessive insulin production is a risk factor for type 2 diabetes and gestational diabetes. This is why it is so important for women with PCOS to follow a modified low GI/low inflammatory/ style diet and that the number one treatment for assisting PCOS (as recommended by the World Health Organisation) will always be diet and lifestyle changes.

Young women with PCOS at risk

This new study investigated 54,680 women in total and found that younger women with PCOS are now more at risk of developing diabetes than older women with the disease. The study found that the risk factor for developing diabetes is four times greater for younger women. This is probably due to poor diet and lifestyle choices that many young women are choosing these days.

The increased risk of developing type 2 diabetes is an important finding and this is something that women with this disease should know, especially those who are obese and have PCOS as well. But it is important for women that are of normal weight, or even underweight to know that they are also at an increased risk as well. Just because you are underweight, or of normal weight, doesn’t mean you cannot have PCOS, or be at risk of diabetes.

This new research was carried out by Denmark-based scientists and the findings were published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

If you do need help with managing PCOS and dietary and lifestyle changes, then please call my friendly staff and book in for a consultation with me.

Regards

Andrew Orr

-Women’s and Men’s Health Crusader

-“No Stone Left Unturned”

-The Women’s Health Experts

Copy of Endometriosis Facts There is no cure for endometriosis

Hysterectomy “DOES NOT” Cure Endometriosis

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Many women are led to believe that hysterectomy is a cure for endometriosis and this is probably one of the most non-factual statements that many healthcare professionals are guilty of telling women. This is because they lack the understanding of the disease and lack knowledge of how the disease can spread to other areas of the body outside the uterus.

For the record, and this is fact, Hysterectomy does not cure, never has cured, and never will be a cure for endometriosis.

Most endometriosis is found outside the uterus and can be found in the pouch of douglas, utero-sacral ligaments, ovaries, intestine, pelvic wall, bladder and it can even spread up into the diaphragm, thoracic cavity, liver, pericardium, rectum and other parts of the body. It has even been found in the brain and distal joints such as the fingers.

All women with endometriosis need to know that endometriosis will still stay in the places mentioned above, irrespective if the uterus is removed, or not.

Many women will often comment that hysterectomy has cured their endometriosis and this is because they have been led to believe what their doctor has told them, they lack the understanding of the disease and they may have had some relief of pain usually associated with their menstrual cycle.

All hysterectomy will do for a woman with endometriosis is stop their menstrual cycle and any associated symptoms and pain associated with her menstrual cycle. Some women are also just lucky to become asymptomatic after hysterectomy too.

The type of hysterectomy may also help to slow the progression of the disease too. What many people do not understand it they there are two types of hysterectomy. One is a full hysterectomy, where the uterus and ovaries are removed and the other is a partial hysterectomy, where only the uterus is removed and the ovaries are left behind. It may be possible that a full hysterectomy, where the ovaries are removed, may in fact reduce some of the estrogen that is driving the disease and make someone asymptomatic.

The other gynaecological issue that many healthcare practitioners misdiagnose and overlook is Adenomyosis. Adenomyosis is an inflammatory disease deep within the wall, muscle and tissues of the uterus. Many now believe that Adenomyosis and endometriosis are one in the same disease, except Adenomyosis is deep within the muscles and tissues, where as endometriosis tends to be more superficial.

Removal of the uterus will in fact help Adenomyosis and help with the associated symptoms, such as heavy bleeding and pain.

Many women actually have Endometriosis and Adenomyosis at the same time and many do not even know they have both diseases. Then when the uterus is removed, women experience less pain and symptoms, or no pain and symptoms, that was actually caused by the Adenomyosis rather than the endometriosis.

Then these women are led to believe that they have been cured of endometriosis due to the resulting levels of pain and symptoms that are now gone. But, while their Adenomyosis may be cured (and I use this term loosely due to context), their endometriosis still remains.

But if they are now asymptomatic, which many women are, they many not know that the endometriosis is actually still there. If you are one of these people I do need you to know that the hysterectomy has not cured your endometriosis at all and it is still there in your body. If a hysterectomy has cured your pain and associated symptoms is because of everything I have mentioned above. Again, hysterectomy DOES NOT cure endometriosis.

I also see the opposite of this in practice too. Many women whom have had a hysterectomy are still getting lots of abdominal pain, intestinal pain, bladder pain, rectal pain and others pains in the body. It is often hard for them to hear that their pain they are experiencing is actually from endometriosis, which they have been previously diagnosed with, yet believe has been cured due to the removal of the uterus and sometimes ovaries are well (partial, or full hysterectomy).

The only way that many will actually fully believe you is after they have had further surgery and the disease is found and excised and their symptoms are stopped, or reduced. It is not until then, that these women will know what you have said to be true and that they have been sold the biggest lie on the planet.

The reason I wanted to speak about this is because I see so many women believing that hysterectomy (partial or full) will cure their endometriosis and have been sold the lie.

Unfortunately many of these women are still suffering greatly and are often left wondering why, or are told it can’t be endometriosis as the uterus has been removed. It is so terrible to hear this and see this statement being spread as gospel by healthcare practitioners and even surgeons who know no better and do not understand endometriosis as a disease state.

It is also hard to hear other women tell their fellow sisters the same lie, even though it is not really their fault and they actually do not know any better. I am writing this so the truth is out there and we get to stop this misinformation from spreading any further.

I hope this has helped you with getting some of the facts and see why so many women are told the one of the biggest lies in healthcare.

Oh and remember one more thing….  Period Pain is not normal, no matter what anyone tells you!

Take care

Regards

Andrew Orr

-Women’s and Men’s Health Crusader

-“No Stone Left Unturned”

-Period Pain is not normal

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Atrophic Vaginitis

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Atrophic vaginitis is a vaginal disorder that usually happens after menopause, but it can happen long before this time as well. When estrogen levels fall, the vaginal walls can become thin, dry, and inflamed. This then causes the surrounding tissue to lose its elasticity and become atrophied.

This can be uncomfortable and it can make sex uncomfortable, or extremely painful. Gynaecological conditions such as endometriosis, adenomyosis and fibroids can make someone more prone to atrophic vaginitis as well.Many women that have atrophic vaginitis may not even know that they have it.

As many as 40% of postmenopausal women experience symptoms of atrophic vaginitis after menopause, but only 20 to 25 percent will seek medical help.

Many women will not seek treatment because they feel embarrassed due to the sensitive nature of the condition. Some women just put up with it believing it is normal.

Untreated, it can affect a woman’s quality of life and even lead to increased risk of prolapse and other gynaecological and urological conditions. Many of the treatments are non-invasive and are very effective in a short amount of time.

Symptoms of Atrophic Vaginitis

  • vaginal dryness
  • pain during sexual intercourse, or dyspareunia
  • thin, watery, yellow or gray discharge
  • paleness and thinning of the labia and vagina
  • irritation when wearing certain clothes, such as tight jeans, or when on a bike seat
  • more frequent urinary tract infections (UTIs), or urinary tract like infections(which is from inflammation, with no infection present)
  • Vaginal Prolapse

Symptoms can also present in issues with the bladder and urination

  • painful urination
  • blood in the urine
  • increased frequency of urination
  • incontinence
  • increased likelihood and occurrence of infections, or irritation to the bladder that may feel like an infection

There may also be a reduction in pubic hair, and the vagina may become narrower and less elastic, which may cause a condition called vaginismus.

Causes

During perimenopause, menopause and post-menopause, a woman can have decreased levels of estrogen. When the ovaries stop making estrogen after menopause, the walls of the vagina become thin, and vaginal secretions are reduced. Similar changes can happen to women after childbirth, but these changes are temporary and less severe.

These same changes can happen for women with endometriosis and adenomyosis and often why there can be changes to the wall of the vagina. Some of the medications used to help these conditions can also cause thinning of the vaginal wall and surrounding area. Many women with endometriosis, adenomyosis, fibroids etc, will have increased risk of atrophic vaginitis during the perimenopause, menopause and post-menopausal period.

Medications, or hormones, can be used as part of the treatment for breast cancer, endometriosis, adenomyosis, fibroids, or infertility to reduce estrogen levels. This decrease in estrogen can lead to atrophic vaginitis.

Other causes of atrophic vaginitis include:

  • severe stress
  • depression
  • Surgery, or treatment to the pelvic area
  • uncontrolled diabetes
  • rigorous exercise
  • chemotherapy

Other substances that can cause further irritation to the vagina are:

  • smoking
  • soaps
  • laundry detergents
  • lotions
  • perfumes
  • douches
  • tampons
  • yeast infections
  • condoms (due to latex allergy)

Diagnosis

The best person to see for this condition is a pelvic floor/urodynamic specialist, or a women’s health specialist. While you GP can help with diagnosis of this condition, it is preferable to see a specialist who has more training in this condition and can help manage this moving forward. A specialist will carry out proper examinations, be able to diagnose this correctly and ask about medical history. They may ask about the use of agents that can irritate the area and cause or aggravate symptoms, such as soaps or perfumes.

Your specialist will also do tests to rule out STI’s and other possible causes of infections such candidiasis, bacterial vaginosis etc. Atrophic vaginitis can make the area more susceptible to becoming infected. It can occur alongside an infection. A diabetes test may be performed to rule out diabetes. A biopsy may be taken to rule out cancer.

Treatment

The first line treatment is usually conservative treatments with topical estrogen creams inserted into the vagina and focuses treatment on the affected area. A low-dose estrogen cream can be used to stimulate rapid reproduction and repair of the vaginal wall, tissue and cells. Women should be shown how to insert the creams with an applicator and then use their finger to help disperse the cream properly to get good coverage of the vaginal wall.

Creams are much better than pessaries, because pessaries often do not disperse well and may only give coverage to a small area. These creams are also safe to use for those at risk of certain cancers, or who have had hormone dependent tumors.

Some women may also need to take Hormone Replacement Therapy (HRT), in the form of a tablet, gel, patch, or implant to supply estrogen to the whole body. These estrogens are effective, but there may be side effects. Patients should discuss the risks of long-term HRT (especially breast cancer risk) with their healthcare practitioner.

Some women may also need to use a water-soluble vaginal lubricant may help to provide relief during intercourse, for mild cases.

Regular exercise is important, as it keeps blood flow and genital circulation high. Pilates and yoga may be beneficial for the pelvic floor and core stability and should be part of a woman’s overall lifestyle management. Women in the perimenopause and menopausal periods of their life should be doing some form of weight baring and strengthening exercise regularly.

There are also natural medicines that may assist in the treatment of  atrophic vaginitis. Acupuncture and Chinese herbal medicine may help and assist with the symptoms of atrophic vaginitis (such as pain), alongside medical treatments.

Prevention

Regular sexual activity and stimulation of circulation to the vagina can help prevent atrophic vaginitis. It is more around climax helping, rather than just sexual activity, or intercourse. Some women have pain during intercourse, or experience dryness, so foreplay and being well lubricated can help this. Using a water-soluble vaginal lubricant can soothe mild cases during sexual intercourse. Masturbation and stimulation without intercourse to produce climax may help those women who have pain with intercourse, or who may not have a partner.

Regular climax and sexual activity can also show benefits for both the elasticity and flexibility of the region. Women who have regular climax and are sexually active report fewer symptoms of atrophic vaginitis when compared to women who do not regularly climax, or have regular sexual intercourse.

Regular exercise, such as Pilates and Yoga may assist in helping with the pelvic floor, vaginal tone, bladder and reproductive organs. Kegels exercises, and vaginal eggs/stones may also assist with atrophic vaginitis, alongside medical interventions.

There are natural medicine which may assist with the prevention of atrophic vaginitis and assist with circulation and hormone regulation. To find out more, please consult your healthcare provider.

Fast facts on atrophic vaginitis

  • Atrophic vaginitis refers to dryness of the vagina.
  • Symptoms include painful intercourse and an increase in urinary tract infections (UTIs), or urinary tract like infections (due to inflammation of the bladder, not from infection).
  • It is caused by a reduction in estrogen, normally following menopause or treatment with anti-estrogen drugs. It can also be caused from gynaecological conditions such as endometriosis, adenomyosis and fibroids.
  • Topical treatments and hormone replacement therapy (HRT) may help relieve symptoms
  • Around 40 percent of postmenopausal women experience symptoms of atrophic vaginitis, but many do not seek treatment.

If you do need help with suspected atrophic vaginitis,please see your healthcare provider, or see a specialist in this area.

Take care

Regards

Andrew Orr

– Women’s and Men’s Health Advocate

-“No Stone Left Unturned”

-The Women’s Health Experts

Iron Infusion

Could you need an Iron Infusion?

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Iron infusion: Uses, benefits, and what to expect

As a healthcare practitioner I am used to seeing women with really low iron, due to various gynaecological conditions.

Many women do not even know they are low in iron until they get bloods tests to show that they are. Being low in iron can be very dangerous for a woman on so many levels.

Many women who are suffering from fatigue are actually low in iron.

Symptoms of low iron can include

Fatigue

Dizziness

Fainting, or feeling of feeling faint

Pale skin

Breathless

Frequent headaches

Palpitations, or racing heart

Easily irritated

Difficulty in concentrating

Cracked, or reddened tongue

Loss of appetite

Strange food cravings

Risk Factors For Low Iron

Heavy menstrual bleeds

Endometriosis

Adenomyosis

Fibroids

Coeliac disease

Inflammatory Bowel Disease

Pregnant and Breast Feeding Women

Certain Cancers

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Girls going through puberty

Certain illnesses

Sometimes when Iron gets too low, supplements just will not be enough to get iron levels up to where they should be quick enough. This is where iron infusions can be very effective.

So what is an Iron Infusion?

An Iron infusion is when iron is delivered via an intravenous line into a person’s body.

Increasing the amount of iron a person has in their blood can cure anaemia, or increase a low red blood cell count.

The body uses iron to make hemoglobin. Hemoglobin is an important part of red blood cells and helps carry oxygen around the body.

If a person does not have enough hemoglobin, they can feel tired, or have symptoms mentioned previously. An iron infusion may be used for someone with an iron deficiency when supplements do not work.

As discussed before, there are a variety of medical reasons can cause low iron levels, so your doctor, or healthcare specialist will order iron studies and other tests to see what may be causing someone to be deficient in iron.

An iron infusion may be given if a person’s blood counts are so low that taking iron supplements or increasing their daily intake of iron-containing foods would be ineffective or too slow in increasing their iron levels.

What to expect

A person will go to a doctor’s office, hospital, or another healthcare facility to have an iron infusion. This is done intravenously and the infusion will take between 15-30 minutes if it is given in amounts of 200-300 milligrams (mg). In days gone by iron infusions would take hours to do and would have to be done in a hospital setting.

The new rapid iron infusions allow iron into the body much quicker and have little to no side effects compared to the older solutions that took hours to administer and were not as good as the new versions used now.

What happens after an iron infusion?

An individual can experience some mild side effects after an iron infusion. The symptoms are usually mild side effects such as headaches, metallic taste in the mouth, or some mild joint pain. Some people can feel faint and nauseas after an infusion but this is usually people who do not tolerate having blood taken, or having needles given. Reactions to infusion are rare, but your healthcare provider will explain all this too you. There are some people who may be allergic to iron, just like people can be allergic to certain foods.

Most people will only need one infusion done, but sometimes people with very low iron may need multiple infusions done. This will be after careful monitoring and testing to see where your iron levels are.

Usually iron levels will return to normal and symptoms of iron deficiency will decrease several weeks after the infusion. A doctor will regularly check the person’s iron levels and blood counts to ensure the iron infusion is working.

Iron infusion vs. injection

Doctors can administer iron to someone via an injection or an infusion.

Iron injections are given intramuscularly, but while iron injections may be faster than iron infusions to administer, they can have some unpleasant side effects. Some of the side effects can be pain at the site of the injection, bleeding into the muscle, and permanent discoloration at the injection site. This is why more doctors are now recommending iron infusions over the injections

Before and after the Infusion

Most people do not need to fast or stop taking their medications beforehand, and can also resume their everyday activities after an iron infusion.

If a person is taking regular iron supplements, however, a doctor will usually tell them to stop taking these about a week before the procedure. This is because the supplements may prevent the body from absorbing the iron from the infusion efficiently.

A person will need to resume iron supplements at some stage after the receiving iron infusions, t ensure levels stay where they should be. Your healthcare provider will tell you when to do this.

People who have a genetic issue called haemochromatosis should not ever have an iron infusion.

Iron infusions are now being used more and more, when iron levels are low and people are not responding to supplementation and adjustments to their diet. I recommend them to many of my patient who have low iron due to many varying reasons. Like I said said before, many of my gynaecology patients, fertility patients and pregnancy patients have very low iron levels and will actually need an infusion to get their levels up quickly.

If you are feeling tired, lethargic and may be at risk of low iron, have a talk to your healthcare provider about finding out if you are low in iron and also discuss having an iron infusion if your levels are really low. Your healthcare practitioner may not know about the new iron infusions and that they are now a great option to use and have very little side effects compared to the older methods and solutions. Some GP clinics now specialise in administering iron infusions too.

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

Dr Andrew Orr Logo Retina 20 07 2016

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The Toxic Consequences of Sugar on Mental Health

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When sugar cravings set in, the last thing we might think of is how this may affects our long-term mental health. There is now so much research to suggest that we should be thinking about the toxic consequences of sugar much more.

After a stressful day and when our moods can sometimes be low, it is all to easy to reach for sugary treats. But sugar can also be in the form of savoury things too. We need to remember that savoury things convert to sugar and may have hidden sugars as well. There is so much evidence to show the link between sugar and chromic inflammation and now the evidence around it affecting mental health and mood disorders is increasing.

Previously, I shared some new research in post about the greater risk of depression in men and women who consumed significant amounts of sugar in their diet. A few people commented that feeling depressed may lead to increased sugar consumption, rather than the other way around. However, what was really interesting about this study was that the researchers, from University College London Institute of Epidemiology and Public Health in the United Kingdom, used a mathematical model to exclude exactly that. This is known as reverse causation.

Using data from a large group of civil servants in the U.K. – they showed that sugar consumption came before depression, rather than being a consequence of it.

Diet and mental health are linked

When people ask me for help with mood disorders, I always tell them that a multimodality approach is needed, which encompasses changes to diet and lifestyle. It isn’t just about taking a pill. To be honest, there are no magic pills for mood disorders so people need to stop looking for them. True help come from changes to diet, changes to lifestyle, talk therapy, medicines and treatments that have been shown to help mood disorders.

In 2002, a study from the University of Texas Southwestern Medical Center in Dallas showed that the overall sugar consumption per person in six different countries (Canada, France, Germany, Korea, New Zealand, and the United States) implicated sugar as a factor in higher rates of major depression.

There have been many other research teams that have investigated the effect of diet on mental health. For example, consumption of processed food, take-away foods and fast food – including hamburgers, pizza, and fried foods – was found to be higher in both children, teenagers and adults with increased rates of depression.

A study of Chinese adults, who traditionally drink unsweetened tea , also showed that those who drank soft drinks and other sweetened drinks had higher rates of depression.

The science of sugar

Sugars are simple carbohydrate molecules. While being essential for cell and organ functioning, our bodies have sophisticated machinery to break complex carbohydrate molecules into simple sugars. Sugars therefore do not need to be added to the diet and our bodies do not need added sugar to function properly. Refined carbohydrates (bread, cereals, pastas, sweet drinks etc) all convert to sugar very quickly. This makes the blood sugars spike and causes the body to store fats and also stop the burning of fats. It also causes inflammation in the body, which is the cause of many disease states and health issues that we all face.

What is really important understand is that our bodies do not differentiate between sugars from different sources. Whether it comes from white sugar, honey, molasses, corn syrup, concentrated grape extract, fruit, or milk, our bodies use the sugar in exactly the same way. Sugar is sugar, not matter what sources it comes from. We can try and sugar coat it (pardon the pun) and dress it up to look healthy, but at the end of the day, it is not healthy for us and is causing major issues with our health, both physically and mentally.

The daily recommended intake of sugar is roughly about 6 teaspoons of sugar for women and 9 teaspoons for men. Even that is probably way too much. To put that into context, a can of Coca-Cola contains up to 10 teaspoons of sugar, while a small banana contains about 3 teaspoons. When people add up what they have in a day, they might be very surprised. Add in some bread, some pasta, some dried fruits, some juice, some sugar in your tea and coffee and it all starts to add up exponentially. We really do consume a lot of sugar.

Sugar affects on the nerves and brain

Neurons are very sensitive cells and are not well prepared for sugar level spikes. In fact, individuals with diabetes are at risk of neuron and nerve damage, and scientists now understand how high blood sugar causes this.

Researchers from Huazhong University of Science and Technology in Wuhan, China, performed studies on diabetic rats and showed that high blood glucose led to chronic inflammation and neuronal damage and death in the brain. Importantly, there is a strong link between diabetes and Alzheimer’s disease, further supporting the claim that sugar toxicity has a role in brain health.

How to cut down your sugar intake

Cutting sugar from our diet may be easier said than done and these we are bombarded with advertisements for convenience foods and tasty treats. But even seemingly healthful foods can have high levels of hidden sugars. This is where many people get caught out. Food such as breakfast cereals, sauces (including ketchup and pasta sauce), dried fruits, gluten free products, flavoured milks, wholemeal bread, and many products labelled as low fat, such as fruit yogurts, low fat milk etc.

The other food that often get overlooked are fruit juices and so called healthy smoothies. A study published in the British Medical Journal last year showed that over 40% of the smoothies and fruit juices for children contained at least 19 grams of sugar. That is a lot of sugar for an to ingest, let alone a child. High levels of sugars are also in many toddler and baby foods too.

The best way to keep tabs on sugar consumption is to become familiar with nutritional labels. While some products may claim that they have no added sugars, the nutrition facts panel will show the amount of carbohydrates and sugars in the product. It is really important to read these panels because some of what you are ingesting may shock you. Just beware of clever marketing and advertising.

It is so important that we all start to look at foods and start to choose foods that are low in refined ingredients, such as sugar and other additive, but high in protein, omega-3 fatty acids, vitamins, minerals, amino acids and other nutrients that can relieve the symptoms of depression. Scientists are now seeing that these foods are promoting good brain health, which is great to see.

The next time stress and low mood threatens to spoil your day, remember that good foods can help you and remember where that sugar can actually make your moods worse.

Let’s not forget that trying to withdraw off sugar can be harder than coming off some hard core drugs. Sugar is highly addictive and does have drug like effects on the body. Don’t believe me?

Try it sometime and see how hard it is.

Take care

Regards

Andrew Orr

-Women’s and Men’s Health Advocate

-“No Stone Left Unturned”